Inverse Care Law for Yorkshire and Humber General Practice?

Leeds University medical students Christopher Hogg and Naomi Sharpe recently completed analysis which shows practices and CCGs located in areas of socioeconomic deprivation in Yorkshire and Humber have fewer GPs per head of population than practices in more affluent areas.

They also found that there was a strong correlation between unplanned hospital admissions and increasing levels of socioeconomic deprivation and a moderate strength correlation between patient to GP ratios and unplanned hospital admissions (i.e. fewer GPs per capita was associated with higher admission rates).

These findings are in line with existing literature of deprivation, GP numbers and unplanned hospital admission.

In a 2015 analysis of general practice in Scotland, Mclean and colleagues at Glasgow University found that, despite higher consultation rates and substantially greater rates of multi-morbidity and premature mortality, there were the same or slightly fewer GPs serving Scotland’s poorest areas. Researchers at the York Centre for Health Economics reached similar conclusions in their 2016 longitudinal analysis of GP to patient ratios in England, where it was found that GP to patient ratios were lower in the poorest areas in 2004/5 but had flattened out (and were actually slightly greater) by 2013/14, mainly due to Walk-In centres and other national policy initiatives. These centres were excluded from Hogg and Sharpe’s analysis, which may be why there is a difference in the findings. The York team have also found that deprivation is strongly associated with unplanned hospital admissions, especially via the Emergency Department.

Whilst Hogg and Sharpe’s research does not establish causality, taken with the existing literature, it provides a regional focus and strengthens the case for increasing GP to patient ratios in the most deprived areas to reflect unequal health outcomes and attempt to make the NHS more sustainable by reducing costly unplanned hospital admissions.